Outcome and Failure Analysis of 132 Episodes of Hematogenous Periprosthetic Joint Infections—A Cohort Study

Renz, Nora; Trampuž, Andrej; Perka, Carsten; Rakow, Anastasia

doi:10.1093/ofid/ofac094

Cited by 16 publications

(26 citation statements)

References 29 publications

(52 reference statements)

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“…While for hematogenous infection, the clinical problem is whether the microbes detected from blood samples are causative pathogens, rather than whether the microbes could be detected. Rakow et al found that more than 61% of pathogen (43/70) causing hematogenous periprosthetic joint infection can be successfully detected from blood samples (Renz et al, 2022). For AHO, we found that the coincidence rate (sensitivity) of blood mNGS tests (77.3%) against final clinical diagnosis was slightly lower than that of puncture fluid mNGS (89.4%).…”

Section: Discussionmentioning

confidence: 53%

The diagnostic value of blood metagenomic next-generation sequencing in patients with acute hematogenous osteomyelitis

Zhang

Chen²,

Yao³

et al. 2023

Front. Cell. Infect. Microbiol.

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AimsThis study aims to evaluate the diagnostic value of blood metagenomic next-generation sequencing (mNGS) in detecting pathogens from patients clinically diagnosed as acute hematogenous osteomyelitis (AHO).MethodsThis retrospective study enrolled 66 patients with AHO. The test results of mNGS and bacterial culture on different samples, including blood and puncture fluid samples, from patients with AHO were compared to explore the diagnostic value of blood mNGS. Besides, this study also explored the efficacy of blood mNGS in decision making for antibiotic administration and analyzed the factors associated with the positive result of blood mNGS.ResultsThe most common causative pathogens were Staphylococcus and Streptococcus. The sensitivity of blood mNGS (77.3%) was higher than that of blood culture (42.4%) (P<0.001), while the turnaround time of blood mNGS (2.1 ± 0.4 d) is much less than that of blood culture (6.0 ± 2.1 d) (P<0.001). Besides, the sensitivity of blood mNGS tests (77.3%) was slightly lower than that of puncture fluid mNGS (89.4%). Furthermore, detection comparison at pathogen level unravels that blood mNGS might be suitable for diagnosing AHO caused by common pathogens, while puncture fluid mNGS could be considered as preferred examination in diagnosing AHO caused by uncommon pathogens. Finally, three independent factors associated with the true positive result of blood mNGS in patients with AHO were identified, including Gram-positive pathogens (OR=24.4, 95% CI = 1.4-421.0 for Staphylococcus; OR=14.9, 95%CI= 1.6-136.1 for other Gram-positive bacteria), body temperature at sampling time (OR=8.2, 95% CI = 0.6-107.3 for body temperature of >38.5°C; OR=17.2, 95% CI = 2.0-149.1 for patients who were chilling), and no use of antibiotics before sampling (OR=8.9, 95% CI =1.4-59.0).ConclusionThis is the first report on evaluating and emphasizing the importance of blood mNGS in diagnosing AHO. Blood sample might be an alternative sample for puncture fluid for mNGS, and its extensive application in diagnosing AHO could be expected.

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Section: Discussionmentioning

confidence: 53%

The diagnostic value of blood metagenomic next-generation sequencing in patients with acute hematogenous osteomyelitis

Zhang

Chen²,

Yao³

et al. 2023

Front. Cell. Infect. Microbiol.

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“…For instance, sequentially performed joint resection and implantation surgeries with existing sepsis could cause systematic inflammation response syndrome and multiple organ dysfunction syndrome. Alternatively, at least the second-stage implanted prosthesis must be removed again [ 8 ]. Moreover, the patient has to stay in bed for an additional several weeks and undergo extra surgeries.…”

Section: Introductionmentioning

confidence: 99%

Retrospective Study from a Single Center to Identify Risk Factors Associated with Reinfection in Patients Undergoing 2-Stage Revision Surgery for Periprosthetic Joint Infection

Zhang

Liu

et al. 2022

Med Sci Monit

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Background This study identified risk factors associated with reinfection and created a scoring system designed for patients with periprosthetic joint infection (PJI) who have undergone prosthetic resection and spacer implantation. Material/Methods Patients who underwent 2-stage revision for PJI from January 2010 to December 2017 were retrospectively analyzed in this study. Patients were divided into 2 groups: infection recurrence and infection cure. Demographic and clinical information, laboratory test results, and radiological images that were potentially associated with infection were obtained and analyzed. Results Seven independent risk (protective) factors for infection recurrence in patients with PJI who underwent 2-stage hip revision surgery were identified: C-reactive protein level, type of bacterial infection, age, immunosuppression, albumin/globulin ratio, glucose level, and magnetic resonance imaging findings. Finally, a weighted scoring system of 100-mark system was established and the area under the curve was 0.965 (95% confidential interval=0.947–0.983). The predictive scores for low risk (≤30%), moderate risk (31–69%), and high risk (≥70%) of infection recurrence were ≤45, 46–77, and ≥78, respectively. Conclusions For patients with PJI who had already undergone joint resection and spacer implantation, this newly established scoring system might help determine the accurate risk of infection recurrence after a definitive new prosthesis implantation. Patients with scores greater than 78 points would be considered very likely to have an infection recurrence. Therefore, the second-stage revision surgery should be changed to an additional anti-infection treatment or a debridement surgery instead of a definitive prosthesis implantation surgery.

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“…Various competing treatment approaches have been published. The recommendations of the International Consensus Meeting (ICM) 1 , Musculoskeletal Infection Society (MSIS) 2 and Infection Disease Society of America (IDSA) 3 are mainly implemented in North America, and the concepts of the European Bone and Joint Infection Society (EBJIS) 4 and PRO-IMPLANT Foundation 5 are widely used in Europe. Despite differences in the treatment approaches, it is consent that a multidisciplinary team is crucial for successful treatment.…”

Section: Introductionmentioning

confidence: 99%

“…If the abovementioned period is exceeded, chronic infection with a mature biofilm is expected, making prosthesis exchange necessary for the eradication of infection 6 . Depending on the detected pathogen, soft tissue conditions and patientʼs compliance, revision surgery can be performed in a single- or multistage procedure 5 .…”

Section: Introductionmentioning

confidence: 99%

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Does the Implementation of the PRO-IMPLANT Foundation Treatment Algorithm Improve the Outcome of Chronic Periprosthetic Knee Infections? Mid-Term Results of a Prospective Study

et al. 2021

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Background Several treatment options for chronic periprosthetic joint infections have been published in the current literature, with an on-going discussion to determine effective management algorithms. Objectives To compare outcomes of the two-stage exchange procedure in revision TKA prior to and after implementation of the PRO-IMPLANT Foundation treatment algorithm. The primary endpoints were defined as (i) revisions during the interval time, (ii) duration of the interval time and (iii) successful PJI eradication. Material and Methods Between 02/2013 and 09/2016, 122 patients were included in a single-centre cohort analysis. 55 patients were treated according to the previously used algorithm (K1) and 67 according to the PRO-IMPLANT Foundation algorithm (K2). A minimum follow-up period of 3 years was set as the inclusion criterion. Successful eradication of infection was defined in accordance with the consensus criteria by Diaz-Ledezma et al. Results Successful eradication was achieved in 42 (67%) patients in K1 and 47 (85.5%) in K2 (p ≤ 0.005). The mean interval time was 88 days (range 51 – 353) in K1 and 52 days (range 42 – 126) in K2 (p ≤ 0.005). In K1, a mean of 0.8 (range 0 – 6) revisions were necessary during the interval period compared with 0.5 (range 0 – 4) in K2 (p = 0.066). Conclusion Implementation of the PRO-IMPLANT treatment algorithm led to significant improvement in the outcome of periprosthetic joint infections. During mid-term follow-up, infection eradication was highly successful, with decreases in the interval time as well as the number of revisions.

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Outcome and Failure Analysis of 132 Episodes of Hematogenous Periprosthetic Joint Infections—A Cohort Study

Cited by 16 publications

References 29 publications

The diagnostic value of blood metagenomic next-generation sequencing in patients with acute hematogenous osteomyelitis

The diagnostic value of blood metagenomic next-generation sequencing in patients with acute hematogenous osteomyelitis

Retrospective Study from a Single Center to Identify Risk Factors Associated with Reinfection in Patients Undergoing 2-Stage Revision Surgery for Periprosthetic Joint Infection

Does the Implementation of the PRO-IMPLANT Foundation Treatment Algorithm Improve the Outcome of Chronic Periprosthetic Knee Infections? Mid-Term Results of a Prospective Study

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